What is BLUETAIL MEDICAL GROUP, LLC.'s NPI number?

The NPI number assigned to this healthcare provider is 1285986398, enumerated as a organization on October 12, 2012.

Where is the provider located?

The provider is located at 13353 OLIVE BLVD CHESTERFIELD, MO 63017 and the phone number is (636) 778-2900.

What is the provider's specialty?

The provider's specialty is Orthopaedic Surgery with taxonomy code 207XX0005X and a focus in Sports Medicine.

BLUETAIL MEDICAL GROUP, LLC. - NPI 1285986398 - Orthopaedic Surgery in Chesterfield, MO

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About Bluetail Medical Group, Llc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLUETAIL MEDICAL GROUP, LLC. (NPI 1285986398) is a healthcare organization registered as a sports medicine in Chesterfield, Missouri and active in the NPI registry since October 2012. The organization holds a CLIA Waiver certificate valid through November 24, 2026, maintains 8 additional practice locations, and lists Joe O'neil, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1285986398

Entity TypeOrganization

Primary Taxonomy207XX0005X

Legal Business NameBLUETAIL MEDICAL GROUP, LLC.

Location Address13353 OLIVE BLVDChesterfield, MO 63017-3108

Mailing AddressPo Box 11665Belfast, ME 04915-4007 · (636) 778-2900 · Fax (636) 778-2828

Phone(636) 778-2900

Fax(636) 778-2828

Organization SubpartNo

Authorized OfficialJoe O'neilPractice Administrator · (636) 778-2900

Enumeration DateOctober 12, 2012

Last NPPES UpdateNovember 17, 20254 updates tracked since enumeration

NPPES CertifiedNovember 17, 2025

✔ NPI 1285986398 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207XX0005X

License✔ Licensed in MO · LC1262307

Definition

An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.

Also ListedClinic/CenterTaxonomy 261Q00000X

13353 OLIVE BLVD, Chesterfield, MO 63017

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Secondary Practice Locations 8

Location 1101 Hodencamp Rd Ste 102Thousand Oaks, CA 91360-5831 · Phone (636) 778-2900

Location 236 Old Kings Hwy S Ste 105Darien, CT 06820-4523 · Phone (636) 778-2900

Location 31875 Veterans Park Dr Ste 2201Naples, FL 34109-0596 · Phone (239) 631-1960 · Fax (239) 631-5967

Location 41575 Lookout DrNorth Mankato, MN 56003-2503 · Phone (636) 778-2900

Location 52807 W Broadway Ste 107Columbia, MO 65203-1317 · Phone (636) 778-2900

Location 63852 Creamery RdDE Pere, WI 54115-9210 · Phone (636) 778-2900

Location 7516 E State Road 32Westfield, IN 46074-8767 · Phone (636) 778-2900

Location 8160 Westmount DrFarmington, MO 63640-2970 · Phone (636) 778-2900

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2202148

Bluetail Medical Group, LLC · Naples, FL

Active · expires Nov 24, 2026

CLIA Number10D2202148

Laboratory TypePhysician Office

Certificate Effective DateNovember 25, 2024

Certificate Expiration DateNovember 24, 2026

Laboratory DirectorLuga Podesta

Laboratory Phone(239) 631-1960

Laboratory LocationBluetail Medical Group, LLC1875 Veterans Park Drive, Suite #2201, Naples, FL 34109

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DOUGLAS ALLEN BOULDIN FNP-C

Nurse Practitioner